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[IgA 肾病(伯杰病)的形态学。免疫组织学、光镜和电镜检查结果]

[Morphology of IgA nephritis (Berger disease). Immunohistologic, light- and electron microscopic findings].

作者信息

Dunker H, Nizze H

出版信息

Zentralbl Allg Pathol. 1987;133(3):263-78.

PMID:3630435
Abstract

An IgA nephritis was diagnosed in 109 (24%) out of 445 renal biopsies with glomerular disease in the years from 1977 to 1985. The mean age of the patients in question was 29 years. The male:female sex ratio was 2.6:1. Immunohistologically, the characteristic branching mesangial IgA deposits were uniformly present. In addition 96% showed mesangial C3 and 54% mesangial IgG and/or IgM deposits. Besides, immunoglobulin and/or C3 deposits could be detected at glomerular basement membranes (20%). The histological types of IgA nephritis were minor glomerular abnormalities (10%), focal/segmental glomerulonephritis (29%), diffuse mesangioproliferative (58%), membranoproliferative (1 case), and sclerosing glomerulonephritis (2 cases). Additional tubulointerstitial lesions were found in 55%. Electron microscopically, in 53 cases under study, mesangial electron dense immunodeposits were seen. At the glomerular basement membranes, deposits could be found only in 23 examined cases (43%). The comparison of clinical data with morphological findings showed relationships between the degree of proteinuria and creatinine level increase with the histological type of IgA nephritis and with the degree of glomerular sclerosis, tubulointerstitial lesions, and electron microscopically proved glomerular basement membrane deposits. Hematuria seemed not to correlate with the morphological picture.

摘要

在1977年至1985年期间,445例肾小球疾病肾活检中有109例(24%)被诊断为IgA肾病。这些患者的平均年龄为29岁。男女比例为2.6:1。免疫组织学检查显示,特征性的分支状系膜IgA沉积物均有出现。此外,96%的病例显示系膜C3沉积,54%显示系膜IgG和/或IgM沉积。此外,在肾小球基底膜也可检测到免疫球蛋白和/或C3沉积(20%)。IgA肾病的组织学类型包括轻微肾小球异常(10%)、局灶/节段性肾小球肾炎(29%)、弥漫性系膜增生性(58%)、膜增生性(1例)和硬化性肾小球肾炎(2例)。55%的病例发现有额外的肾小管间质病变。电子显微镜检查显示,在53例研究病例中可见系膜电子致密免疫沉积物。在肾小球基底膜,仅在23例检查病例中发现沉积物(43%)。临床数据与形态学结果的比较显示,蛋白尿程度和肌酐水平升高与IgA肾病的组织学类型、肾小球硬化程度、肾小管间质病变以及电子显微镜证实的肾小球基底膜沉积物有关。血尿似乎与形态学表现无关。

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